Bike System For Use In Rehabilitation Of A Patient

ABSTRACT

A system for use in rehabilitation of a target patient is provided. The system includes at least two bicycle devices for use by the target patient and a second operator other than the target patient. The at least two bicycle devices each include pedals. At least one of the pedals may have at least one sensor mounted thereon for monitoring operation of the first bicycle device and the target&#39;s condition. A servomotor is coupled to the pedals for providing gear-like resistance or pedal assistance for the at least two bicycle devices. A controller is programmed to electrically couple the at least two bicycle devices to each other.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to U.S. Provisional Patent ApplicationSer. No. 62/091,214, filed Dec. 12, 2014, by the same title.

BACKGROUND OF THE INVENTION

This disclosure relates to a method and apparatus for rehabilitation ofa patient with movement or neurological disorders attendant to strokes.Parkinson's disease. Huntington's disease, Alzheimer's disease and thelike. The invention finds particular application in using a bike systemwith a controller to sense, control and dynamically alter arehabilitation program for a patient with Parkinson's disease. While theinvention herein will be described with particular reference toParkinson's disease, it will be readily appreciated that it is relevantto treatment of those conditions just mentioned.

Parkinson's disease (PD), which affects approximately one million peoplein the U.S. and 7 to 10 million people worldwide, is a chronic,progressive neurological disorder that is characterized by the loss ofdopaminergic neurons in the brainstem. The main symptoms of the diseaseare movement disorders, and include shaking or tremor, muscle stillnessand rigidity, and slowness of physical movements (i.e., bradykinesia).As PD progresses, the combined motor and non-motor symptoms often leadto reduced independence and increased reliance on caregivers and thehealthcare system. The economic impact of PD, including treatment,social security payments, and lost income from inability to work, isestimated up to $25 billion per year in the United Suites.

There is no known cure for this degenerative disease that results inprogressive deterioration of motor skills along with other reducedphysical and mental functions. The accepted treatment for PD ismedication (e.g. levodopa) and in some cases surgical intervention (e.g.deep brain stimulation). These treatments only mask the symptoms and donot slow progression of the disease. Furthermore, they often haveundesirable side effects, are costly and can introduce additional healthrisks. Considering these deficiencies, there is it need for innovativetreatments to prevent, delay disease progression, and improve thesymptoms of PD.

Recent studies have shown that exercise and movement therapies havesignificant benefits for individuals with PD, but there is littleconsensus on the optimal mode or intensity. Several studies havedocumented the benefits of high-cadence tandem cycling for motorfunction improvement in PD riders. However, the effective factors ofexercise (e.g., rpm, intensity, intervention type, duration of theexercise, and the like), which constitute an optimal exerciseintervention for PD patients, are still unknown. For example, each PDpatient has different symptoms and skill levels, which makes itchallenging to design a general rehabilitation system that gives themaximum benefit to all PD patients. Moreover, progression of the diseaseoften requires re-assessments and modifications of the motorrehabilitation programs.

Several studies have shown a significant improvement in patient motorskills from tandem cycling. However, even with the exceptional resultsreported from tandem cycling, large-scale use of the tandem cyclingparadigm for exercise therapy is not feasible for several reasons.First, tandem cycling requires an able-bodied trainer to assist inpedaling that is not reasonable in large-scale clinical deployment orin-home use. Second, variability in trainer pedaling speed, stamina, andresponse to the PD rider's performance creates variations that make dataanalysis and conclusions in clinical studies difficult to generalize.Third, there are a number of factors, such as cadence, foot position andworkload that can affect the biomechanics of cycling and resultantperformance. Many motorized single-rider stationary exercise bikes arecommercially available today that can provide a pre-programmed loadprofile for the rider. However, it has not been possible to reproducethe dynamics of the tandem bike cycling paradigm using currentlyavailable motorized cycles.

SUMMARY OF THE INVENTION

In one embodiment, a system for use in rehabilitation of one or moretarget patients is provided. The system includes at least two bicycledevices for use by the target patient(s) and a second operator otherthan the target patient. The at least two bicycle devices each includepedals. At least one of the pedals may have at least one sensor mountedthereon for monitoring operation of the first bicycle device and thetarget's condition. Alternatively, the monitoring can be undertaken byother means, such as the drive for a servomotor coupled to the pedalsfor providing gear-like resistance or pedal assistance for the al leasttwo bicycle devices. A controller is programmed to electrically couplethe at least two bicycle devices to each other and control theservomotor.

In another embodiment, a system for use in therapy of a target patientis provided. The system includes at least one bicycle device for use bythe target patient and a second operator other than the target patient.The bicycle devices include pedals. At least one of the pedals may haveat least one sensor mounted thereon for monitoring operation of thefirst bicycle device and the target's condition. A servomotor is coupledto the pedals for providing gear-like resistance/assistance for the atleast one bicycle device. A controller is programmed to acquire datarelated to target patient performance obtained from the at least onesensor, and adjust operation of the system responsive to the targetpatient performance.

In a further embodiment, a system for use in rehabilitation of a targetpatient is provided. The system includes a first bicycle device for thetarget patient. The first bicycle device includes pedals. At least onesensor monitors operation of the first bicycle device and the target'scondition. A servomotor is coupled to the pedals for providing gear-likeresistance/assistance for the first bicycle device. A second bicycledevice is provided for a second operator other than the target pattern.The second bicycle device includes pedals.

At least one sensor monitors operation of the second bicycle device andthe second operator's condition. A servomotor is coupled to the pedalsfor providing gear-like resistance for the second bicycle device. Acontroller is electrically programmed to couple the first and secondbicycle devices to each other, acquire data related to target patientperformance obtained from the at least one sensor, and adjust operationof the system responsive to the target patient performance.

Further scope of the applicability of the presently describedembodiments will become apparent from the detailed description providedbelow. It should be understood however, that the detailed descriptionand specific examples, while indicating particular embodiments of thepresent disclosure, are given by way of illustration only, since variouschanges and modifications within the spirit and scope of the presentdisclosure will become apparent to those skilled in the art.

BRIEF DESCRIPTION OF THE DRAWINGS

the presently described embodiments are described in the construction,arrangement, and combination of the various parts of the device, and themethod, whereby the objects contemplated are attained as hereinaftermore fully set forth, specifically pointed out in the claims, andillustrated in the accompanying drawings in which:

FIG. 1 is a first schematic view of a tandem bike according to oneembodiment of the present disclosure;

FIG. 2 is a second schematic view of the tandem bike of FIG. 1;

FIG. 3 is a plan view showing the coupling of the tandem bike of FIG. 1;

FIG. 4 is a schematic view of a controller of the tandem bike of FIG. 1;

FIG. 5 is a plan view of the assembled tandem bike of FIG. 1;

FIG. 6 shows a control architecture for the bike controller of FIG. 4;

FIG. 7 is a schematic view of an electrical coupling of two bike systemsaccording to another embodiment or the present disclosure;

FIG. 8 presents an algorithm of a controller of the bike systems of FIG.7; and,

FIG. 9 is a second schematic view of the algorithm of a controller ofthe bike systems of FIG. 7.

DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS

As shown in FIG. 1, a tandem bike or system 10 which accommodates theinteraction and power sharing between a trainer (i.e., a leader) and arider (i.e., a follower) is provided. Advantageously, the tandem bike 10eliminates the need for a mechanical coupling of pedals (not shown inFIG. 1) of the tandem bike 10 by replacing the mechanical coupling withelectronic coupling. In one example the electronic coupling is providedby a programmable logic controller 12.

The tandem bike 10 operates in two modes: 1) data acquisition; and 2)real-time bike control. Advantageously, a common chain that mechanicallyconnects the two riders is removed, and the controller 12 electricallylinks two or more users together. For example, the controller 12 inoperating mode 1 is used to collect real-time performance data from theusers (i.e., a trainer and a rider) using sensors and devices connectedto, for example, bike pedals, as described in more detail below. Thesynchronized data samples are analyzed to determine the couplingcharacteristics (such as amplification, attenuation, drag, elasticity,and backlash, and the like) in the electrical coupling. Subsequent dataanalyses examine the response of the trainer to disturbances (from therider) and develop a model of how the trainer interacts with the rider.For example, the controller 12 is programmed to collect performance datafrom each of the target patient and the second operator. In the contextof the invention, the controller 12 may be any appropriate programmablelogic controller, dedicated microprocessor, computer or similar device.

In operating mode 2, the model and information obtained during operatingmode 1 are used to connect the trainer and rider electronically in thetandem bike 10. In this case, the trainer and the rider areelectronically linked as if they were mechanically connected through astandard tandem bicycle drivetrain (i.e. chain-coupled sprockets). Forexample, the controller 12 generates a mathematical model of aninteraction between the target patient and the second operator from theperformance data. The mathematical model provides the electricalcoupling of the two riders.

In another example, the controller 12 is programmed to collect data fromother similar patients that are stored in a database. In such instances,the controller 12 includes a data-mining processor (not shown) thatcollects data related to patients with similar conditions and symptomsas a target patient. The data-mining processor is programmed with aclassification algorithm to mine a historical database (not shown) tocollect the data related to patients with similar conditions andsymptoms as a target patient. From this collected data, the controller12 is programmed to generate a statistical model. The controller 12 isthen programmed to adjust operation of the tandem bike 10 responsive toeach of the mathematical model and the statistical model.

From the mathematical model and/or the statistical model, the controller12 is programmed to dynamically alter the cadence and torque experiencedby the trainer and rider. In one example, the controller 12 alters thecadence and torque experienced by the trainer and rider through areal-time power management control algorithm, as described in moredetail below. In another example, the controller 12 alters the cadenceand torque experienced by the trainer and rider through amachine-learning algorithm. In this mode, the tandem bike 10 operateswith a trainer and rider in both acquisition and closed-loop controlmodes, or with n single rider (i.e., no trainer) where inputs to therider are provided by an input reference trajectory inputted by atrainer into the controller 12.

In some instances, a trainer model (not shown in FIG. 1) is integratedwith the controller 12 of a single tandem bike 10. The trainer modelserves to provide the feel and experience of a tandem bike to a rider ona single automated bike. The testing, data analysis, and modelattenuation may be performed to validate the test platform for use insubsequent clinical trials and to enable improved motor functionbenefits for PD riders.

As shown in FIG. 2, the tandem bike 10 includes a plurality ofservomotors 14 and 16 that each includes a motor drive control 18 and 20associated therewith. Various sensors (not shown in FIG. 2) are alsocoupled to a portion of the tandem bike 10 (e.g., the pedals). Thecontroller 12, the servomotors 14 and 16, the motor drive controls 18and 20, and the sensors are each coupled to a data acquisition system22. The testing, data analysis, and model development, along with otheroutputs from use of the tandem bike 10 are displayed on a display 24operably connected to the controller 12. Unlike typical tandem bikes,the bike 10 has non mechanical interconnection between the tandemsections as by a chain or belt, but rather a virtual interconnectionthrough the controller 12, motor drive controls 18, 20 and associatedmotors.

The servomotors 14 and 16 are capable of providing gear-like resistanceto a user. Since the tandem bike 10 imitates two-person tandem bikebehavior, each of the two servomotors 14 and 16 service a separaterider. Each of the servomotors 14 and 16 is wired to an associated oneof the motor drive controls 18 and 20, which are wired to the controller12, thereby forcing the motors 14 and 16 to react to the users' increaseor decrease in pace.

The tandem bike 10 may be commercially available and modifiable, or,alternatively, may be specifically designed and constructed. In oneexample, the tandem bike 10 can be rack mounted to enable stationarycycling. In another example, the tandem bike 10 can be movable bypedaling, in which case the tandem bike carries a battery power source.PLC and the like. In some instances, the tandem bike 10 is modified byremoving the mechanical coupling (e.g., the shared chain). In someexamples. The servomotors 14 and 16 are directly connected to crankassemblies (not shown in FIG. 2) through auxiliary sprockets and chains,as well as replacing the bikes' cranksets with the power-meter crankset.The tandem bike 10 requires the servomotors 14 and 16 to provideresistance by attachment to bike pedals 26 and 28 with two additionalchains (not shown). In one example, the power management controlalgorithm of the controller 12 alters the speed and torque delivered tothe pedals 26 and 28 by the servomotors 14 and 16.

In one example, a commercially available tandem bike 10 is outfittedwith the controller 12, the servomotors 14 and 16, the motor drivecontrols 18 and 20, and the data acquisition system 22. To establish theelectrical control, for operating modes 1 and 2, the chain (not shown)is removed, and the controller 12, the servomotors 14 and 16, and themotor drive controls 18 and 20 link the riders electronically. A rack 30is provided for rack-mounting the bike to provide stationary operationthereof. As shown in FIG. 3, the servomotors 14 and 16 are installed ona chassis 32 of the tandem bike 10.

As shown in FIG. 4, the controller 12 is operably connected to thetandem bike 10. The controller 12 includes a logic processor 34. Thelogic processor 34 communicates with the display 22 and the motor drivecontrols 18 and 20 through an Ethernet network to send and receivecommands and data. The logic processor 34 determines the appropriatemotor speed and load (e.g., torque) values and transmits thisinformation to the motor drive controls 18 and 20. Each motor drivecontrol 18 and 20 includes a high-speed inner loop controller 36 and 38that are operably connected to the controller 12 and the first andsecond servomotors 14 and 16, respectively. The loop controllers 36 and38 provide the appropriate voltage and current to the servomotors 14 and16 to continually maintain the operating state of the servomotors 14 and16 specified by the logic processor 34. As shown in FIGS. 5 and 6, motorfeedback from the servomotors 14 and 16 to the motor drive controls 18and 20 is used to maintain proper motor speed and torque in spite ofload disturbances introduced by the rider. For example, as shown in FIG.6, the data can pass through a feedback data loop which includes aseries of filters (e.g., low pass filters, moving average fillers, andthe like).

As shown in FIG. 4, the tandem bike 10 is also equipped with the display22 (e.g., a rugged touch screen device). The display 22 serves as thehuman-machine interface for the tandem bike 10 and communicates with thelogic processor 34 through Ethernet to send the parameters entered bythe trainer to the logic processor 34 and to receive and display therequired data from the logic processor 34. The display 22 also providesa graphical plot showing historical values for bike and rider operation.

The controller 12 includes multiple software programs and controlalgorithms developed to run and control the tandem bike 10. The controlalgorithms that operate the tandem bike 10 are developed and implementedinto the logic processor 34. The developed algorithms are downloaded tothe logic processor 34 to provide real-time control of operation of thetandem bike 10. The logic processor 34 includes the control algorithmsfor use with the development and operating platform (i.e. the display22, the servomotors 14 and 16, the motor drive controls 18 and 20)provided with the tandem bike 10. Multiple commercially-availablesoftware development tools are used to develop the algorithms androutines, establish communication with the devices to download the code,and to transmit and display the data. In one example, the logicprocessor 34 includes a main control algorithm that electrically couplesthe cranksets of the tandem bike 10 to each other. In another example,the logic processor 34 includes algorithms for programming andcontrolling the servomotors 14 und 16, thereby allowing the servomotors14 and 16 to be controlled and run independently. Software in the logicprocessor 34 is developed such that the rider tracks the speed of thetrainer, while the two users share the power required to pedal thetandem bike 10.

The logic processor 34 electronically couples the servomotors 14 and 16in such a way that the tandem bike 10 emulates a mechanical couplingthereof. In other words, in contrast to a standard tandem bike with amechanical coupling between the two sets of pedals, the inventionemploys an electronic coupling that emulates the mechanical coupling. Apreferred situation occurs when the riders have exactly the same cadence(i.e., velocity) and power is shared between the riders. In one example,as shown in FIG. 7, the logic processor 12 electronically links tworiders on the tandem bike 10 by coupling two single-rider bikes 10′ and10″ to behave like the tandem bike 10 shown in FIG. 1, thereby allowingusers to bike together in different locations and feel like they arecycling on the tandem bike 10 linked with a traditional chain coupling.The desired signals can be transferred via internet or other datanetworks, both wired and wireless. The two single-rider bikes 10′ and10″ replicate the behavior of one of the tandem riders, advantageouslyallowing single PD riders to benefit from the effects of tandem cycling,even within their own homes. For example, when the operator of the firstbike 10′ takes the larger portion of the power/torque, the operator ofthe second bike 10″ provides the lower amount of power, and vice versa.In one example, a target patient operates one of the single-rider bikes10′ and a second user different from the first user a trainer, anotherpatient, and the like) operates the other of the single-rider bikes 10″.In another example, the target patient operates one of the single-riderbikes 10′ and controller 12 operates the other of the single-rider bikes10″. The concept of the invention applies not only to bikes and thelike, but other therapeutic devices as well, such as stepping machines,ellipticals, treadmills and the like.

In some embodiments, the controller 12 is programmed to include a humanin the loop control system (not shown) programmed to monitor theoperation of the tandem bike 10. In such examples, the loop controlsystem is programmed to perform at least one of the following tasks;react and adapt to changes initiated by at least one of the targetpatient and the second operator; detect and accommodate inappropriateinteraction by at least one of use target patient and the secondoperator: accommodate different skill level and competency levelsbetween the target patient and the second operator; detect and respondto wear and fault conditions of the system; and protect the at least oneof the target patient and the second operator and the system. The loopcontrol system operates as a “fail-safe” for the tandem bike 10 byoperating as a protection mechanism. In some instances, the human in theloop control system can include a plant component and a plant modelcomponent. For example, the plant exponent includes actual output dataof the target patient, the second operator (e.g., the trainer, the otherpatient, the controller 12, and the like) and the tandem bike 10. Statedanother way, the plant component encompasses the tandem bike 10 and theusers. In another example, the plant model component includes anexpected output data of the target patient, the second operator, and thesystem. The human in the loop control system is programmed to adjust theoperation of the tandem bike 10 based on a comparative analysis of thedifferences between the actual output data of the plant component andthe expected output data of the plant model component. This residualanalysis may serve to identify equipment problems, rider condition(e.g., fatigue) or model deficiencies.

In another embodiment designated by the numeral 40 as shown in FIG. 8,real-time data signals as well as previously recorded data (e.g.,changes in motor function, bike signals, physiological data, and thelike) are used to compute adaptive exercise parameters within theexercise session as well as session by session. The adaptive exercisesystem 40 exports appropriate control parameters for the tandem bike 10considering target Unified Parkinson's disease rating scale (UPDRS)changes. During the exercise, bike and patient signals are beingprocessed in real-time to evaluate the exercise quality and calculatethe expected UPDRS change. The adaptive exercise system 40 applies theresults to the controller 12 to modify the control parameters. Thesedata are also logged to be used in future sessions. Accordingly, thesystem optimizes the rehabilitation paradigm during a therapy session uswell as between sessions, using target and projected UPDRS (UnifiedParkinson's Disease Rating Scale) on a therapy device. Moreover, thecontroller 12 provides a platform for automatically controllingrider-bike interaction to optimize the benefit from accelerated dynamiccycling. Although the foregoing is discussed in regards to UPDRS, otherPD measures and standards may be used to estimate rider condition orrider motor skill level.

The exercise system 40 is dynamic and adaptive, providing the optimalexercise program for the rehabilitation of individuals with differentskill levels and improvement profiles. Exercise programs are optimizedfor each patient based on the individual conditions and skill level toprovide the most benefit for the patient. Moreover, online data analysispermits rapid identification of problems, rider fatigue, or unusualbehavior and allows for corrective control action and provides superiorrider safety. Furthermore, data logging and remote access capabilitycould be used by physicians, trainers, and therapists interested inmonitoring in-home progress of PD patient exercise. Some or all elementsof session planning, data analysis, data logging, or database may bedone on multiple processors, remote processors, or cloud-basedplatforms. For example, the components of the tandem bike 10 may bepackaged in a single module, or distributed geographically and linked bythe multiple processors, the remote processors, and/or the cloud-basedplatforms.

In one example, as shown in FIG. 8, the adaptive exercise system 40 is aclosed loop adaptive control of the exercise parameters of the tandembike 10 during a training session. During a planning session,appropriate control parameters of the tandem bike 10 are adjusted inview of target UPDRS changes. For example, during a training session,signals from the users and the tandem bike 10 are processed in real-timeby the controller 12 to evaluate the exercise quality and calculate theexpected UPDRS change to create a feedback loop. In another example, thecontroller 12 may input disturbances in order to enhance therapeuticvalue or to probe the tandem bike 10 for improved state estimation. Thefeedback loop applies the results to the current planning session tomodify control parameters of the tandem bike 10. This data can also bestored and used in future planning sessions. The controller 12 alsoprovides a platform for automatically controlling user-tandem bike 10interaction to optimize accelerated dynamic cycling benefits. A controloutput may include tandem bike 10 values and/or user control values orparameter limits or constraints (e.g., limits on rider input torque,heart rate, and the like). For example, the control parameters caninclude speed, torque, load share amount, pedal coupling lag,disturbance amplification, and the like.

In another example, as shown in FIG. 9, the adaptive exercise system 40also includes a session by session control scheme, which extends theadaptive exercise system 40 to future exercise sessions. An exerciseplanning module provides appropriate data and instructions related touser/tandem bike 10 performance to the adaptive exercise system 40during a training session based on previous user/tandem bike 10 data andtarget UPDRS data. The controller 12 runs and controls the tandem bike10 during the rehabilitation session based on the information providedby the planning module. Alter each rehabilitation session, actual UPDRSdata is measured, and expected UPDRS data is calculated, based onrecorded data from the user and the tandem bike 10 during therehabilitation session. The actual UPDRS data and the expected UPDRSdata is collected and stored for use by the planning module for planningthe next rehabilitation session, although the planning module may beimplemented without an actual UPDRS measurement. From this, individualswith different skill levels and improvement profiles can be optimizedfor use with the tandem bike 10 and the controller 12. In one example,the optimization process may prescribe specific set point value for somevariables. In another example, the optimization process may also specifyconstraints or permissible ranges for some variables (e.g., speed, heartrate, and the like). In addition, the adaptive exercise system 40 alsopermits rapid identification of problems, rider fatigue, or unusualbehavior for corrective control action and provides safely for theuser(s), as described in more detail below.

To do so, in some instances, the adaptive exercise system 40 can includea plant component and a plant model component. For example, the plantcomponent includes actual output data of the target patient, the secondoperator (e.g., the trainer, the other patient, the controller 12, andthe like) and the tandem bike 10. In another example, the plant modelcomponent includes an expected output data of the target patient, thesecond operator, and the system. The human in the loop control system isprogrammed to adjust the operation of the tandem bike 10 based on acomparative analysis of the differences between the actual output dataof the plant component and the expected output data of the plant modelcomponent.

In other instances, the adaptive exercise system 40 can include amodel-based control model for providing the user with an experiencesimilar to riding a tandem bicycle and a captain model (i.e., an expertmodel) for sensing capabilities of the rider and adjusting a processcontrol for the tandem bike 10 accordingly. In one example, thecontroller 12 is programmed to emulate an experience of riding a tandembike for the user via the control model. In another example, the captainmodel can be a domain expert model and/or an expert operator model. Forexample, the captain model can sense capabilities of the users andadjust the operation of the tandem bike 10 accordingly. Specifically,the captain model is programmed to assess parameters related to therider (e.g., health condition, skill level, and the like) and alter adisplay, prompts, and/or limits on a rider input device (not shown). Inaddition, during a rehabilitation session, the captain model isprogrammed to sense a user's capabilities through the session and set anoptimum therapy regimen and work load to maximize the benefit for theuser while protecting the user from injury and/or fatigue.

In further instances, the controller 12 is programmed to decouple thetandem bike 10 from the user in the controller for segmenting andconcentrating expertise and control information focused on a particularaspect of the control of the tandem bike 10. As a result, the segmentingand concentrating expertise can detect faults or anomalous conditions,effectively prescribe an appropriate response to observed changes in thetandem bike 10 or the user. Consequently, the controller 12 can moreeffectively analyze the operation of the tandem bike 10, the controller12, and the user(s). To do so, the controller 12 can include a therapistmodel processor for input by a trainer; a physician model processor forinput by a trainer; a prediction model processor for predictingperformance output data of the target patient; an optimization modelprocessor for optimizing one or more parameters of a training program;and/or a machinery maintenance model for monitoring to changes to the atleast one bicycle device.

In light of the foregoing, it will be appreciated that the concept ofthe invention can be provided in multiple control architectures,providing both local and remote system operation and coordination. Asingle controller may both control and acquire data from multiple sitesoperating either concurrently or in different time frames, acquiringdata from the sensors of remote devices and adapting the operation ofthose devices as a function of the user's needs and capabilities. Theelectronic nature of the system, replicating physical and mechanicalstructures, provides a unique opportunity to alter the coupling betweenpedal cranks such as either attenuating or amplifying disturbances,replicating various characteristics or anomalies and regulating thetiming of various operations. The data processing and storage operationsare substantially unlimited when the system is configured for acloud-based operation, including both cloud databases and cloud-basedanalytics. The number of sites and users that can be accommodated withsuch a cloud-based operation is substantially limitless. When the usersare geographically distributed, pedal synchronization can beelectronically achieved as if the geographically separated riders wereon the same virtual bike. Timing sequences for accommodating networkdelays for both pedal control and pedal synchronization are also readilyavailable through the centralized digital control. The data processingand electronic controls of the invention also provide for enhancedsafety and security, providing a means of actually confirming rideridentity by noting and comparing the riding characteristics of varioususers, and by employing diagnostics and prognostics attendant to varioussensors connected to the rider, the bike, the motor drive, and the like.Additionally, and as presented herein, the system accommodates theestablishment of a database, including historical data on interventionand resulting outcomes of the various riders utilizing the system, andaccommodates data assessment for use, modification, and adaptation.

Thus it can be seen that the various aspects of the invention have beensatisfied by the structures and techniques presented herein. The abovedescription merely provides a disclosure of particular embodiments ofthe present disclosure and is not intended for the purposes of limitingthe same thereto. As such, the present disclosure is not limited to onlythe above-described embodiments. Rather, it is recognized that oneskilled in the art could conceive alternative embodiments that fallwithin the scope of the present disclosure. For example, while the abovedescription describes specific processors, algorithms, and routines, itwill be appreciated that any type of hardware or software can be usedwith the present disclosure.

While particular embodiments of the invention have been disclosed indetail herein, it should be appreciated that the invention is notlimited thereto or thereby inasmuch as variations on the inventionherein will be readily appreciated by those of ordinary skill in theart. The scope of the invention shall be appreciated from the claimsthat follow.

What is claimed is:
 1. A system for use in rehabilitation of a targetpatient, the system comprising: at least two bicycle devices for use bythe target patient and a second operator other than the target patientthe at least two bicycle devices each including: pedals, indicatingoperation of the first bicycle device and the target's condition; and aservomotor coupled to the pedals for providing resistance or assistancefor the at least one bicycle device; and a controller programmed toelectrically couple the at least two bicycle devices to each other. 2.The system of claim 1, wherein the controller is further programmed toacquire performance data related to each of the at least two bicycledevices.
 3. The system of claim 1, wherein the controller is furtherprogrammed to: collect performance data from each of the target patientand the second operator; and generate a mathematical model of aninteraction between the target patient and the second operator from theperformance data.
 4. The system of claim 3, wherein the mathematicalmodel provides the electrical coupling between the at least two bicycledevices.
 5. The system of claim 3, wherein the controller is furtherprogrammed to: generate a statistical model developed from patient dataof other patients; and adjust operation of the system responsive themathematical model and the statistical model.
 6. The system of claim 5,wherein the controller adjusts operation of the system by being furtherprogrammed to: dynamically alter a cadence and a torque experienced byeach of the target patient and the second operator through a real-timepower management control algorithm.
 7. The system of claim 6, whereinthe controller is further programmed to dynamically alter a cadence unda torque experienced by each of the target patient and the secondoperator through a machine-learning algorithm.
 8. The system of claim 1,wherein the system operates with the target patient operating one of theat least two bicycle devices and a second user different from the targetpatient operating another of the at least two bicycle devices.
 9. Thesystem of claim 1, wherein the system operates with the target patientoperating one of the at least two bicycle devices and the controlleroperating another of the at least two bicycle devices.
 10. The system ofclaim 1, wherein the controller includes a human in the loop controlsystem programmed to: react and adapt to changes initiated by at leastone of the target patient and the second operator; detect andaccommodate inappropriate interaction by at least one of the targetpatient and the second operator; accommodate different skill level andcompetency levels between the target patient and the second operator;detect and respond to wear and fault conditions of the system; and/orprotect the at least one of the target patient and the second operatorand the system.
 11. The system of claim 9, wherein the human in the loopcontrol system include: a plant component that includes actual outputdata of the target patient, the second operator and the system; and aplant model component that includes an expected output data of thetarget patient, the second operator, and the system.
 12. A system foruse in rehabilitation of a target patient, the system comprising: atleast one bicycle device for the target patient, the at least onebicycle device including: pedals, at least one of the pedals having atleast one sensor mounted thereon for monitoring operation of the atleast one bicycle device and a condition of the target patient; aservomotor coupled to the pedals for providing resistance for the atleast one bicycle device; a controller programmed to: acquire datarelated to target patient performance obtained from the at least onesensor; and adjust operation of the system responsive to the targetpatient performance.
 13. The system of claim 12, wherein the controlleris further programmed to acquire performance data related to each of theat least one bicycle device.
 14. The system of claim 12, wherein thecontroller is further programmed to: collect performance data from thetarget patient; and generate a mathematical model of an interactionbetween the target patient and the at least one bicycle device from theperformance data.
 15. The system of claim 14, wherein the mathematicalmodel provides an electrical coupling between a first bicycle device anda second bicycle device of the at least one bicycle device.
 16. Thesystem of claim 15, wherein the target patient operates the firstbicycle device and the controller operates the second bicycle device.17. The system of claim 12, wherein the controller includes a human inthe loop control system, the human in the loop control system including:a plant component that includes actual output data of the target patientand the at least one bicycle device; and a plant model component thatincludes expected output data of the target patient and the at least onebicycle device.
 18. The system of claim 16, wherein the controllerincludes: a control model for providing the user with an experiencesimilar to riding a tandem bicycle; and a captain model for sensingcapabilities of the rider and adjust the process control for the systemaccordingly.
 19. The system of claim 12, wherein the controller includesat least one of: a therapist model processor for input by a trainer; aphysician model processor for input by a trainer; a prediction modelprocessor for predicting performance output data of the target patient;an optimization model processor for optimizing one or more parameters ofa training program; and a machinery maintenance model for monitoring tochanges to the at least one bicycle device.
 20. A system for use inrehabilitation of a target patient, the system comprising: a firstdevice for the target patient, the first device including: footsupports; at least one sensor for monitoring operation of the firstdevice and the target's condition; a servomotor coupled to the footsupports for providing resistance for the first device; a second devicefor a second operator other than the target patient, the second deviceincluding: foot supports; at least one sensor for monitoring operationof the second device and the second operator's condition; a servomotorcoupled to the foot supports for providing resistance tor the seconddevice; a controller electrically programmed to: couple the first andsecond devices to each other; acquire data related to target patientperformance obtained from the at least one sensor; and dynamically andadaptively adjust operation of the system responsive to the targetpatient performance.